ABSTRACT
PURPOSE: To analyze the refractive, topographic, keratometric changes and the histopathologic findings after wedge resection to correct high astigmatism after penetrating keratoplasty for keratoconus. MATERIALS AND METHODS: A retrospective study was done analyzing the following parameters preoperatively and at 1, 3, and 5 years postoperatively: uncorrected visual acuity, best-corrected visual acuity, and spherical equivalent and refractive, topographic, and keratometric cylinder measures. We also studied the efficacy and safety indices, as well as the histopathologic findings of tissues submitted for pathology. RESULTS: A total of 22 eyes of 21 patients who underwent wedge resection in the host corneal tissue for correcting high irregular astigmatism after penetrating keratoplasty for keratoconus were included in the study. Mean follow-up time from penetrating keratoplasty to wedge resection was 18 years, whereas the mean follow-up time after wedge resection was 39.04 months (range, 12-280 months). The mean preoperative refractive, topographic, and keratometric cylinders were 11.58 +/- 3.52 diopters (D) (range, 4.5-20 D), 10.88 +/- 5.03 D (range, 2.58-21.3 D), and 11.29 +/- 4.33 D (range, 4.50-18 D), respectively. The mean postoperative refractive, topographic, and keratometric cylinders at 3 years were 4.91 +/- 2.48 D (range, 0.50-10 D), 3.38 +/- 2.10 D (range, 2.05-7.1 D), and 5.31 +/- 2.90 D (range, 0.50-9 D), respectively. The percentage of correction at 3 years of follow up was 57.5% for refractive cylinder, 68.97% for topographic cylinder, and 53.01% for keratometric cylinder. All refractive, topographic, and keratometric data showed the lowest degree of astigmatism at 3 years postoperatively, with a tendency toward regression at 5 years postoperatively. Safety index was 1.0, whereas efficacy index was 0.49. All histopathologic sections of resected tissue were consistent with keratoconus progression in the host peripheral cornea. CONCLUSION: Wedge resection is a safe and moderately effective procedure in the correction of high astigmatism after penetrating keratoplasty for keratoconus. Histopathologic changes confirm a true late progression of the disease in the host cornea. Keratoconus may be a disease that affects the entire cornea, and surgical resection does not cure the disease.
Subject(s)
Astigmatism/surgery , Keratoconus/surgery , Keratoplasty, Penetrating , Postoperative Complications , Refraction, Ocular/physiology , Visual Acuity/physiology , Adult , Aged , Astigmatism/etiology , Astigmatism/physiopathology , Cornea/physiopathology , Cornea/surgery , Corneal Topography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the long-term visual prognosis of corneal and ocular surface surgery in patients with congenital aniridia. METHODS: Retrospective comparative interventional case series on 88 eyes of 45 patients with congenital aniridia treated and/or operated on from 1956 to present. Corneal and ocular surface findings were identified and patients were classified into operated (group I) or not operated (group II). Long-term best-ever best-corrected visual acuity (BCVA), final BCVA and long-term delta BCVA (long-term best-ever BCVA - final BCVA) were recorded and compared between the two groups, and between the limbal transplant (LT) (group I-A) and the penetrating keratoplasty (PK) (group I-B) patients. Postoperative results were also compared. RESULTS: Limbal insufficiency was present in 58% of eyes and dense central corneal opacities were present in 27% of eyes. As a primary surgery, limbal allograft was performed in 10 eyes and PK in 13 eyes. The mean long-term follow-up times were 23 years in group I and 16 years in group II. The mean long-term delta BCVA was 0.032 in group I and 0.028 in group II. Comparisons of the VA means were insignificant (long-term best-ever, final BCVA and long-term delta BCVA). When comparing the LT and PK groups, mean long-term delta BCVA was 0.0328 in group I-A and 0.0382 in group I-B. Mean postoperative delta BCVA was 0.028 in group I-A and 0.048 in group I-B. We found no statistical significance between the LT and the PK groups as regards long-term postoperative BCVA results. CONCLUSION: Long-term visual prognosis does not differ whether or not the patient undergoes surgery for aniridic keratopathy. LT and PK have comparable results over 5 years of follow-up because of the eventual failure of transplanted allografts.
Subject(s)
Aniridia/complications , Corneal Diseases/etiology , Corneal Diseases/surgery , Keratoplasty, Penetrating , Limbus Corneae/surgery , Adolescent , Adult , Child , Child, Preschool , Corneal Diseases/pathology , Corneal Diseases/physiopathology , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Postoperative Period , Prognosis , Recurrence , Retrospective Studies , Transplantation, Homologous , Visual Acuity , Young AdultABSTRACT
PURPOSE: To study changes in astigmatism throughout a 20-year period using keratometry and refraction in patients who underwent penetrating keratoplasty (PKP) for keratoconus. METHODS: We reviewed the charts of patients who underwent PKP for keratoconus from 1975 to 1979 and recorded preoperative refraction, stage of keratoconus, laterality of surgery, graft size, suture technique, time of suture removal, keratometry, subjective refraction at 1, 3, 5, 7, 10, 15, 20, and 25 years after suture removal, and slit-lamp findings. RESULTS: Eighty eyes with a mean follow-up of 20 years (range, 15-25) were included in the study. Graft size, suture technique, and time of suture removal had no significant influence on the astigmatism at the last examination. We observed a stabilization of keratometric astigmatism in the first 7 years (4.05 +/- 2.29 D 1 year after suture removal, 3.90 +/- 2.28 D at year 3, 4.03 +/- 2.49 D at year 5, 4.39 +/- 2.48 D at year 7) followed by a progressive increase from 10 years after suture removal until the last follow-up visit (5.48 +/- 3.11 D at year 10, 6.43 +/- 4.11 D at year 15; 7.28 +/- 4.21 D at year 20, and 7.25 +/- 4.27 D at year 25). The mean absolute value of the difference vector (DV) calculated by vector analysis was 7.17 +/- 4.35 D (0-18.33). In 70% of cases, progression of the astigmatism was evident with mean absolute DV of 9.10 +/- 3.65 D. There was a significant correlation between the preoperative and final axis of astigmatism (Pearson r = 0.39, p = 0.0008). There was also a slight positive correlation coefficient between the DV of the eyes in bilateral cases, but it was not significant (Spearman's r = 0.2226, p = 0.34). The major late slit-lamp finding was a peripheral crescent-shaped thinning at the graft-host junction with absence of Bowman's layer on histopathology. CONCLUSION: In spite of refractive stability obtained during the first years after PKP for keratoconus, increasing astigmatism thereafter suggests that there is a progression of the disease in the host cornea.
Subject(s)
Astigmatism/etiology , Astigmatism/physiopathology , Keratoconus/complications , Keratoconus/surgery , Keratoplasty, Penetrating , Adult , Cornea/pathology , Disease Progression , Humans , Keratoconus/pathology , Male , Postoperative Period , Recurrence , Retrospective Studies , Time FactorsABSTRACT
Apresentam-se 10 casos de distrofia latice da córnea do tipo 1 (Biber-Haab-Dimmer), dos quais 3 casos näo apresentavam o aspecto biomicroscópico típico (figuras latice). Faz-se também uma ampla revisäo bibliográfica, expondo os aspectos históricos, etiológicos, o tipo de transmissäo, a controvérsia existente quanto a idade de apariçäo dos primeiros sintomas, a evoluçäo natural, características específicas, classificaçäo, histopatologia, diagnóstico, diagnóstico diferencial, terapêutica e recidivas em enxertos. Chama-se a atençäo para os problemas sociais e econômicos da patologia e conclue-se ressaltando os possíveis equívocos diagnósticos que podem ocorrer nos estágios mais avançados da enfermidade
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Corneal Dystrophies, Hereditary/pathologyABSTRACT
Se efectúa una revisión bibliográfica acerca de los aspectos etiológicos, clínicos, histológicos y terapéuticos de la enfermedad de Terrien. Se analiza la experiencia en dos casos avanzados en los que se efectuó una autohomoqueratoplastia anular perforante (AU)
Subject(s)
Adult , Middle Aged , Humans , Male , Corneal DiseasesABSTRACT
Se analizan los resultados de 31 queratoplastias efectuadas en niños entre 0 y 15 años de edad. Se intenta determinar qué factores tuvieron influencia tanto en los resultados tectónicos como funcionales. El tipo de patología, la edad de aparición y las lesiones acompañantes serían los parámetros de mayor trascendencia. Finalmente se reflexiona sobre el criterio para decidir el momento quirúrgico oportuno (AU)
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , CorneaABSTRACT
Se efectúa una revisión bibliográfica acerca de los aspectos etiológicos, clínicos, histológicos y terapéuticos de la enfermedad de Terrien. Se analiza la experiencia en dos casos avanzados en los que se efectuó una autohomoqueratoplastia anular perforante
Subject(s)
Adult , Middle Aged , Humans , Male , Corneal DiseasesABSTRACT
Se analizan los resultados de 31 queratoplastias efectuadas en niños entre 0 y 15 años de edad. Se intenta determinar qué factores tuvieron influencia tanto en los resultados tectónicos como funcionales. El tipo de patología, la edad de aparición y las lesiones acompañantes serían los parámetros de mayor trascendencia. Finalmente se reflexiona sobre el criterio para decidir el momento quirúrgico oportuno
